Children in pain: Girls may be trusted less than boys

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Is she in pain? Research has shown young children don’t experience pain differently on account of gender in the way the adult population does, both in terms of sensitivity and clinical risk. The sex hormones thought to account for the difference are not present before puberty. But adults’ opinions on the pain children feel may differ based on the sex of the child.
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Is she in pain? Research has shown young children don’t experience pain differently on account of gender in the way the adult population does, both in terms of sensitivity and clinical risk. The sex hormones thought to account for the difference are not present before puberty. But adults’ opinions on the pain children feel may differ based on the sex of the child.
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A child’s finger is pricked at a doctor’s office, and the child cries out. “Ow! Ah! Oh!”

How much pain adult Americans think the young patient is suffering will depend on whether they believe the child to be a girl or a boy, according to a study published this month in the Journal of Pediatric Psychology. Those who know the distressed patient as “Samuel” will infer that he is in more pain than those who know the patient as “Samantha,” even though Samuel and Samantha are in fact the same 5-year-old, whose shoulder-length blond hair, red T-shirt and gym shorts don’t immediately suggest male or female characteristics.

The child’s finger-prick test was captured in a short video played for 264 adults, men and women between the ages of 18 and 75. On average, participants told that they were watching a boy’s reaction to his prekindergarten doctor’s visit rated his pain, on a scale from 0 (no pain) to 100 (severe pain), as 50.42, while those instructed that the patient was a girl rated her pain as 45.90. When researchers controlled for explicit gender stereotypes — the belief that boys are more stoic — the difference vanished, suggesting that biases about the willingness of male versus female children to display pain were behind the belief this particular boy was truly in dire straits because he was moved to cry out.

The results, in what lead author Brian Earp described as a “new research area,” contribute to growing understanding of sex differences in pain, a topic that has mainly been studied in the context of adults. They add further dimensions to the exploration of pain assessments biased by race, based on dubious notions about biological differences between blacks and whites. They suggest a possible need for a course correction in pediatric care, where providers may exhibit the same biases.

“Adults have a lot of authority and agency in saying, ‘This is how I feel.’ We express ourselves in nuanced ways,” said Earp, associate director of the Yale-Hastings Program in Ethics and Health Policy. “But young children, and how they’re attended to, depends on the judgments of adults in the room. Understanding the structure of those judgments is important for equitable health care.”

In a finding that surprised the paper’s authors, the downgrading of female pain was driven by female participants, who were more likely than men to say the pain of the subject was less severe when told she was a girl.

“This is a big mystery,” Earp said. “We’re spitballing to come up with a reason.”